Tuesday Q & A: Headaches That Come With Menstruation Can Be Severe
DEAR MAYO CLINIC: I am 38 and have headaches each month around the first day of my period. Over the last year or so they seem to be getting more severe and lasting longer sometimes up to three days. Why might this be happening? Are there ways to prevent or treat it?
ANSWER: It is not uncommon for women to have headaches before and during their periods. These headaches often can be effectively controlled with medication and usually dont require in-depth evaluation. When, as you describe, theres a change in the severity or type of headache, though, then it is time to see your doctor to find out if another underlying medical condition could be causing the headaches.
In most cases, headaches associated with menstruation are triggered by hormone changes. This is particularly true during the days leading up to a menstrual cycle, when estrogen levels fall rapidly. Prostaglandins, natural chemicals made in the lining of the uterus, play a role, too.
Due to these changes, many women have mild headaches, along with other symptoms like bloating and cramping, beginning just before the onset of a period and sometimes lasting a few days after it starts. These headaches tend to be mild. Over-the-counter pain medications are usually all that is needed to manage them.
In some women, though, the headaches that come with menstruation can be more severe. These headaches, called menstrual migraines, typically start two days before a period begins and last until the third day of menses.
Other Causes Of Migraine Attacks
Certain risk factors, such as age and family history, can play a role in whether you get migraine or menstrual migraine. Simply being a woman puts you at increased risk.
Of course, you cant control your sex, age, or family tree, but it may help to keep a migraine diary. This can help you identify and avoid triggers.
Is Your Birth Control Causing Headaches
Headaches are sometimes a side effect of hormonal birth control . In one study, taking oral contraceptives affected migraines, with 24% of people experiencing increased frequency of migraines .
Estrogen-withdrawal headaches are a type of headache that people get during their âpill-freeâ or âsugar-pill weekâ when they are taking oral contraceptives. This type of headache usually goes away within 3 days, but then will return during the estrogen-free week of the next cycle .
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What Is Menstrual Migraine
First, letâs make sure weâre all on the same page about what âmenstrual migraineâ actually means. Menstrual migraine is a type of migraine that always happens just before or at the beginning of your period. Apart from that, theyâre no different from any other migraine attacks, although they can be longer and more painful than non-menstrual attacks .
Oestrogen Build Up Headaches:
A simple description of a menstrual cycle is as follows:
- The menstrual cycle of most women lasts 28 days, however this may vary in some women.
- The first day of menstruation is regarded as day one of your cycle. On day one, both oestrogen and progesterone levels are low and both levels remain relatively low for most of the first half of your cycle.
- However, around day 12 of the cycle, the oestrogen does have a mid-cycle surge just prior to ovulation and then drops off again.
- After ovulation, the oestrogen starts its climb towards the end of the cycle. A day or so before the next bleed, the oestrogen level drops off again.
- The progesterone is expected to keep pace with the increase of oestrogen and is thought to âbalance out the oestrogenâ and helps to offset the possible side effects of too much oestrogen.
- If there is insufficient progesterone being produced or your oestrogen receptors are overly sensitive to oestrogen, this gradual build-up of oestrogen may cause headaches.
- Other symptoms that may accompany this oestrogen build-up include:
- Skin changes like acne
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Tips To Prevent Headaches Before Your Period
Though there is still research coming out about headaches, many times they can be prevented, or at least lessened by daily habits. If you get headaches regularly during your period, doctors can prescribe a preventative medicine to help offset them. Medications have a wide range of options, from beta blockers and anticonvulsants to antidepressants and magnesium .
Yet, before turning to medication, it helps to try lifestyle modifications first. Some common triggers during your period include skipping meals. This wreaks havoc with your blood sugar, so make sure to eat three meals a day and healthy snacks in between. Avoid foods with too much salt, sugar, and preservatives which can bring on a headache.
Not getting enough sleep can also induce a headache, but so can sleeping too much . Ironically, it can be more difficult to sleep during PMS, so try these tips: Go to bed at the same time every night, darken your room, keep it at a cool temperature, and cut out screen time an hour or two before you go to sleep. Avoid caffeine and big meals before bed. To curb your stress, be preemptive and take a yoga class or practice mindful meditation. Even simply saying no can help keep too many things off your plate, which may do wonders for lowering stress levels.
Hormonal Headache Vs Menstrual Migraine
While a hormonal headache and a menstrual migraine are both caused by fluctuating hormones, the difference between the two involves the severity of the head pain.
A hormonal headache may be mild to moderate and cause a nagging ache or throb. Its a nuisance and uncomfortable, but it might not interfere with your day-to-day routine.
A menstrual migraine, on the other hand, can be debilitating. According to the National Headache Foundation, menstrual migraine affects about 60 percent of women.
If you regularly experience migraine attacks, you may be susceptible to menstrual migraine.
A menstrual migraine differs from a regular migraine in that it isnt usually associated with an aura. Aura refers to flashing lights, zigzag lines, or other sensory experiences that some people experience before a migraine attack.
A menstrual migraine is characterized by severe throbbing that can start on one side of the forehead and travel to the other. The severity can make it difficult to keep your eyes open, work, or even think.
Treatment for a hormonal headache and a menstrual migraine depend on the severity.
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Is There Any Way To Treat It
You can treat period-related diarrhea the same way you would any other bout of diarrhea.
First, make sure youre drinking plenty of fluids to counteract the fluid loss from diarrhea. As a general rule, youve been drinking enough fluids when your urine is pale yellow.
In addition, its a good idea to avoid foods known to make diarrhea worse, including:
- artificial sweeteners
- very sugary foods
In rare instances, you may find you need to take over-the-counter anti-diarrheal medications, such as loperamide . You can also take also try taking an OTC pain reliever, such as ibuprofen , to help with cramping.
Early Symptoms Of Pregnancy
Feel you may be pregnant? There are other early signs that may help clue you in. Nausea with or without vomiting is one of the more classic symptoms associated with pregnancy. While its often called morning sickness, nausea may strike at any point during the day.
Other early symptoms include:
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Ways To Manage Bad Headache During Period
Which Menstrual Migraine Treatment Is Right For Me
Your doctor can help you decide which options are best for you. It may be a combination of strategies, including mini-prevention, acute treatment, and lifestyle changes. Or they may recommend continuous birth control.
âYou have many useful options and most of them are safe,â Sheikh says. But everyoneâs different and it depends on many factors. âItâs important to take an individual approach,â she says.
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Headaches And Women: What Do Hormones Have To Do With It
A bad headache can ruin your workday, strain your relationship with family members and affect your ability to exercise. In the U.S., headaches cause 112 million sick days each year. While one-third of the population gets headaches, women suffer more than men do.
Changes in hormones could be among the reasons women have more headaches than men do.
These hormone-related headache triggers include:
Menstrual Migraine Is Tough To Treat
Menstrual and menstrually related migraine can be the hardest kind of migraine to treat. can be pretty severe, they can last several days, and they can be quite debilitating, she says.
Even if you have migraine attacks only around the time of your period, for many women that may still mean five days or more a month, says Hindiyeh. In that case, its really time to talk to your doctor about daily preventive treatment options for migraine, she says.
Generally speaking, there are many treatment options for the prevention of migraine and menstrual migraine, says Hindiyeh. Heres a rundown of top medications and lifestyle modifications that can help reduce the frequency and severity of menstrual and menstrually related migraine attacks.
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Oral Contraceptives May Reduce Menstrual Migraine Frequency
There is some evidence to suggest that certain types of oral contraceptive pills can actually reduce the frequency of menstrual migraine and menstrually related migraine, Hindiyeh says.
This doesnt apply to all kinds of oral contraception, so you should talk with your gynecologist, primary care doctor, or neurologist about which ones youd want to consider, says Hindiyeh. There are specific ones that will keep your estrogen level from fluctuating so much, she adds.
If youre considering taking oral contraceptives as a means of birth control or to try to improve your migraine symptoms, tell your healthcare provider about your migraine history, says Hindiyeh.
Can You Prevent These Headaches
There are a few methods your doctor might suggest.
Hormonal:Birth control pills or estrogen patches and vaginal rings may help lower the number of menstrual migraines you have or make them less severe. But they donât work for everyone. In some cases, they could make your migraines worse.
Your doctor might tell you to stay on birth control for 3 to 6 months without taking any placebo pills. This will prevent you from having a period and may stop your headaches.
If you get migraines with auras, using birth control that contains estrogen and progesterone isnât a safe option. Taking it could make you more likely to have a stroke. Other reasons your doctor may not want you to take birth control for your menstrual migraines:
- A history of smoking
Medicines that prevent migraines: If you donât respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You can take these regularly to make the headaches less severe or less frequent. These could include:
- Blood pressure medicines , and some antidepressants.
- CGRP inhibitors
Devices: Four devices may bring relief.
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Treatment Of Hormonal Headaches
- antidepressants and/or beta-blockers
Betablockers are traditionally used for treating angina and high blood pressure but its also shown to effectively prevent migraines. It works by slowing the effect of adrenalin and thus slows your heart.
- other prescription medications such as dihydroergotamine.
Dihydroergotamine works by constricting the intracranial blood vessels. It also stimulates serotonin receptors. It can be very effective in severe migraines.
Alternative and Herbal Therapies:
- Acupuncture â studies have shown that acupuncture can be effective in treating the chronic pain of headaches
- Massage with essential oils
Hormones And Head Pain: Whats The Deal
As with most things period related, hormones are to blame. Before your period, estrogen and progesterone levels rise. Then, those levels come crashing down as a signal to your uterus to let that lining go.
This fall in estrogen can trigger headaches. Since birth control regulates this hormonal roller coaster, for some people it can decrease period headaches. For many, birth control makes period headaches worse.
If you have a NuvaRing, headaches during periods are even more common.
Pro tip: If youre already prone to migraines, you should not use the NuvaRing, as it increases your chances of blood clots and continued headaches.
If youre on a hormonal pill based birth control, sometimes skipping the placebo week can get rid of period headaches .
If you noticed your headaches got much worse after starting hormonal birth control, talk to your doctor. You may need to switch pills or your method of birth control to keep headaches at bay.
Though hormones are a background cause of all period headaches, there are four types of menstrual brain pain that are all slightly different.
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How Long Will I Be Having Hormonal Headaches For
A headache may also occur around ovulation time due to the oestrogen surge and consequent drop off.
The majority of women who suffer with migraines in their reproductive years have them premenstrually i.e. leading up to their period. These can occur from a very young age â in her teenage years, and may continue until her hormone levels drop, when she goes into menopause.
Because hormonal headaches depend on the changes of oestrogen and progesterone, as you get older, the hormone headaches become less frequent and will likely disappear altogether. Unfortunately, in some women, they can continue for many decades.
Is It Migraine Or A Headache
Migraine attacks are different than common headaches. They typically cause severe levels of throbbing pain and usually occur on one side of the head. Migraine is categorized as with aura or without aura.
If you have migraine with aura, you may experience one or more of the following symptoms in the 30 minutes before your attack:
- seeing flashes of light
- seeing unusual lines or spots
- a temporary loss of vision
- numbness in the hands or face
- tingling sensations in the hands or face
- changes in speech
- unusual changes in smell, taste, or touch
The symptoms of migraine with aura can also include:
- sensitivity to light or sound
- pain behind one eye or one ear
- pain in one or both temples
Common headaches are never preceded by an aura and are typically less painful than migraine.
There are different kinds of headaches, including:
- Tension headaches. High levels of stress and anxiety can cause tension headaches. They may also be caused by muscle tension or strain.
- Cluster headaches. These headaches are often mistaken for migraine. They typically cause pain on one side of the head and may include other symptoms such as watery eyes, runny nose, or nasal congestion.
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Work With Your Doctor To Come Up With A Mini
Lets say a woman has regular periods every 28 days, and she knows that the day before her period begins, her headache starts. Her doctor might advise her to take an over-the-counter medication like Aleve or a class of prescription medications for migraines, called triptans, two days before her period starts, Halker says.
If she takes it right then, it can help her avoid that headache completely, Halker said.
How To Manage Bad Headache Before Period
Being female comes with its own struggles, especially when it comes to headaches. Fortunately, there’s help.
Over-the-counter pain relievers can be of great help. They may soothe your pain soon after your headache begins.
Triptans are another option. You might feel their effects 2 hours after you take them.
You can also try acupuncture. This ancient Chinese practice may lower the number of tension headaches you get and could prevent a migraine before period.
Many women also report using biofeedback. Biofeedback may relieve your headaches by helping you monitor how your body responds to stress. Apart from biofeedback, you can also try relaxation techniques.
Sometimes, holding an ice pack to the painful area is the best solution. Simply wrap the ice pack in a towel in order to protect your skin.
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What’s The Difference Between A Headache And A Migraine
“A migraine is a type of headache,” Medhat Mikhael, MD, pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center, told POPSUGAR. But there are certain characteristics that help distinguish a migraine from a run-of-the-mill headache. “Migraines are unilateral, pulsating in nature, and associated with one or more of the following: photophobia , phonophobia , and nausea with or without vomiting,” Dr. Mikhael said.
Migraines are also more common in women, a study in The Journal of Headache and Pain found. Women have a 43 percent lifetime incidence of migraines, compared with only 18 percent in men. Before puberty, migraines affect both sexes equally. It’s not until after a woman gets her period and starts experiencing these estrogen fluctuations that they become much more susceptible to migraines than men.